M11 (July 2015) Page 1

Information for request for fee reduction - MR Division

The fee for making an application for review of a migration decision may be reduced if payment of the fee has caused, or is likely to cause, severe financial hardship to the review applicant.

When lodging an application online, if an application fee is applicable, the full fee must be paid as an online payment at the time the application for review is lodged. Any request for fee reduction will be considered after lodgement. If you are deemed to be eligible for a fee reduction, you will be refunded the appropriate amount.

The Registrar or delegate will make the fee reduction decision based on the information you provide on this form and any supporting documents. They may also refer to other information in our possession such as statements you have made to the Australian government regarding your income and financial situation.

Supporting documents

You should attach the following supporting documents to your completed form:

• bank and credit card account statements displaying current balances and transactions overthe past month for all personal and joint accounts; and

• a current payslip or payment statements from Centrelink as well as any evidence ofinvestment income.

You may also provide other documents that demonstrate payment of the fee has caused you, or is likely tocauseyou,severefinancialhardship,suchas:

• evidence of rent/board or mortgage payments, utility, medical or other bills

• evidenceofreceiptofanyfinancialbenefits(suchasaCentrelinkpayment,childsupportpayment, workers compensation, or as a holder of a Commonwealth health care card,pensioner concession card or seniors health card)

• evidence that another agency or organisation has, in respect to you, waived, reduced or notimposedafee(suchaslegalaidorprobonomigrationassistance).

Wearenotauthorisedtocollect,record,useordiscloseyourtaxfilenumber(TFN).IfyouareprovidingdocumentswithyourtaxfilenumberyoumaywishtodeleteyourTFNbeforesubmittingthem.

Important: Supporting documents should be lodged with the completed ‘Fee reduction request’ form. If lodging the form via our online service, all supporting documents are to be scanned into one PDF file. If there are no supporting documents the Registrar or delegate may make a decision based on the information before them, without requesting any further information from you.

Ifyourfeereductionrequestisnotgranted,youmustpaythefullapplicationfee(ifnotalreadypaid)for your application to be valid. If you do not pay the fee your application for review will not be able to proceed. Please note that the Registrar or delegate can only review a fee reduction decision where there has been an error in the decision making process.

M11 (July 2015) Page 2

REQUEST FOR FEE REDUCTIONTo make a decision on your request for a fee reduction, the Registrar or delegate needs information about your financial circumstances. Please answer ‘N/A’ (Not Applicable) if a question is not relevant to your circumstances.

1. Review Applicant

Email:

Case number (if known)

Fax:

2. Do you have any dependants (children or aged relatives)? If yes, provide details

NAME OF DEPENDANTS AGE

Full name:

Postal address:

Daytime telephone number:

Are you currently employed? Yes No

If Yes - please provide:

Occupation

Name of business or employer

3. Do you receive financial support from a partner, relative or friend? If yes, provide details of the person providing financial support and the type and amount of support received.

M11 (July 2015) Page 3

4. Please list all amounts held in bank accounts or accounts with other financial institutions, including details of any accounts held jointly with another person.

Name of bank/institution and account number Value of your share

AU$

AU$

AU$

AU$

TOTAL AU$

5. Do you have any other investments or any money that is owed to you? If yes, provide details here:

6. Please provide details of fortnightly income after tax.

You Your Partner

Salary or wages (after tax) AU$ AU$

Government pension, benefit or allowance AU$ AU$

Child support received AU$ AU$

Rent received from investment properties AU$ AU$

Other investment income AU$ AU$

Worker’s compensation AU$ AU$

Other AU$ AU$

TOTAL AU$ AU$

M11 (July 2015) Page 4

9. Is the application for review in relation to a Student visa or a Visitor visa?

YES NO

If yes, how will your costs to travel and stay in Australia be met if a visa is granted?

7. Expenses - usual fortnightly household expenses. Where expenses are not paid fortnightly, please estimate the average fortnightly amount.

Rent, board or mortgage payments AU$

Utilities - gas, electricity, telephone, water and council rates AU$

Food AU$

Car or transport expenses - registration, insurance, petrol or fares AU$

Health/medical and education or child care AU$

Other AU$

TOTAL AU$

10. Declaration

8 . Do you have any expenses or other debts, loans or financial commitments? If yes, provide details here:

Signature

Name

Date

I declare that all the information provided by me in this form is true and that I can verify the information with original documents. I seek a reduction of the review application fee on the grounds that the payment of the fee has caused me, or is likely to cause me, severe financial hardship.

WARNING: It is an offence to knowingly make a false representation or statement to obtain a benefit or advantage from the Commonwealth. Any person found guilty of these offences can be fined or imprisoned.

If more than one person is included in the application for review, I am authorised to sign on behalf of all applicants.